Cardiovascular Effects of Different GLP-1 Receptor Agonists in Patients with Type 2 Diabetes

Abstract

Use of GLP-1 RAs was associated with relative risk reduction in cardiovascular mortality and all-cause mortality with no significant differences for the incidence of severe hypoglycemia, pancreatitis, pancreatic cancer, or medullary thyroid cancer when compared to placebo. Although there are differences between individual medications with respect to their effects on cardiovascular events, GLP-1 RAs offer a favorable risk-benefit profile. The present review confirms the cardiovascular safety and efficacy vs placebo of GLP-1 RAs in patients with type 2 diabetes at moderate-to-high atherosclerotic cardiovascular risk without significant side effects. Although professional guidelines recommend metformin as the sole first-line agent, GLP-1 RAs can be used as first-line therapy in individuals with type 2 diabetes who either are intolerant to metformin or have high cardiovascular risk factors.

Glucagon-Like Peptide-1 Receptor Agonists in Type 2 Diabetes: Their Use and Differential Features

“…As patients with T2D have an increased risk of adverse cardiovascular (CV) outcomes, current management of T2D includes the reduction of CV risk factors including, but not limited to, hyperglycaemia [39,40]. GLP-1RAs, as a class, provide beneficial effects with regards to several CV risk factors by improving glycaemic control and promoting weight loss (Sect.…”

“…GLP-1RAs, as a class, provide beneficial effects with regards to several CV risk factors by improving glycaemic control and promoting weight loss (Sect. 3), as well as improving factors that are independent of changes in blood glucose [39][40][41][42].…”

“…Between-trial discrepancies may be explained by factors such the heterogeneity across the RCTs, the definitions of composite and individual outcomes, GLP-1RA pharmacokinetics and the degree to which each GLP-1RA may impact modifiable CV risk factors [39][40][41][42]44]. According to a meta-analysis of RCTs of lixisenatide, liraglutide, exenatide ER and semaglutide investigating CV outcomes, overall these GLP-1RAs significantly reduced the risk of MACE by 10%, CV mortality by 13% and all-cause mortality by 12% relative to placebo [48].…”

Anti-Obesity Drugs: Long-Term Efficacy and Safety: An Updated Review

“…Despite initial considerations of the risk of acute pancreatitis, long-term trials suggest that the risk of this disease does not significantly increase with liraglutide [63,64]. Particularly, biomarkers of acute pancreatitis-amylase and mainly lipase-increase in a non-dose dependent manner during treatment with GLP-1 receptor analogs.…”

Treatment With Liraglutide Exerts Neuroprotection After Hypoxic–Ischemic Brain Injury in Neonatal Rats via the PI3K/AKT/GSK3β Pathway

“…Moreover, liraglutide exerts positive effects on weight loss, blood pressure, hyperlipidemia, and glycemic control in the clinic. Thus, many studies have investigated its effects on the cardiovascular, endocrine, and nervous systems (Ishii et al, 2017;Babic et al, 2018;Bahtiyar et al, 2018). In animal models and clinical patients, there were no adverse events or reproductive toxicity found posttreatment with liraglutide.…”